Medical board targets fraud in walk-in clinics

Rent a room, post a sign, hire a doctor or physician's assistant by the hour. Get the right forms, a good forgery of a physician's signature and a list of would-be patients, and the clinic wouldn't need a doctor, much less real patients, to bill insurers for services never rendered.

With medical fraud at walk-in clinics costing Floridians and their insurance companies some $4.8-billion a year, plus billions more in Medicaid money, the state Board of Medicine proposed legislation Friday that would require state oversight and more accountability for all such clinics.

The board voted unanimously to send a proposed bill to the Legislature this spring that would, in part, require all walk-in clinics to register with the state. Clinics also would have to be owned by licensed doctors or physician assistants, or hire a licensed doctor to serve as a hands-on medical director.

If it passes, the law would complement a new board rule that makes doctors at walk-in clinics accountable for ensuring that medical care is adequately documented, lawfully billed and provided by licensed professionals.

"We need to protect the consumers, stop the fraud and return decency to the practice of medicine in every shape and form," Dr. Gustavo Leon, who led a board committee that researched and developed ways to combat fraud, told his colleagues.

The proposed legislation and the new rule are designed to make doctors responsible for the way clinics operate and to make it easier to ferret out fraud. Those who don't follow the rules could face disciplinary action and criminal charges.

The board's attack on fraud stems in part from the findings of two statewide grand juries. One found that although walk-in clinics that accept Medicare or Medicaid patients already submit to government oversight and inspections, some overcharge the system by billions of dollars each year.

The other grand jury investigated clinics that accept only cash or private insurance. It found that some of these clinics, which may hire a doctor by the hour, also over-bill, or bill in the names of doctors who no longer work there.

"Due to the large number of health care providers doing business in Florida, the absence of licensing requirements for certain health care facilities and the tremendous volume of health care claims ... unscrupulous individuals can easily submit and receive payment for fraudulent claims," Beth Blechman, special counsel for health care fraud for the Office of Statewide Prosecutor, told the Board of Medicine.

She said a favorite scheme is called patient brokering, in which a clinic will provide free transportation or even pay people to come by for a checkup. The clinic then will charge patients' insurers for a variety of tests that were never performed.

Judy Rosenbaum, who works the state and federal governments to combat Medicaid and Medicare fraud, said that even though the law forbids insurance fraud, "the system is so vast, unless something comes to the regulators' or investigators' attention, this can go on for a long time. It's catch as catch can."

Florida is one of 14 states that does not require a physician or physician assistant to own a majority stake in a medical clinic. The Florida Medical Association supports the concept behind the proposed law, and Leon said he is trying to line up legislators to sponsor it.

The changes are not likely to affect most legitimate clinics, which typically have licensed medical directors on staff, officials said. Most of the problems have been found in South Florida, but they have been discovered across the state.

"I always invite shaking out the industry of shady operators," said Dr. Al Kaspar,, medical director of Medic-Care Walk-In Clinic in South Pasadena. "If it's going to do that, I think it's great."

The Board of Medicine is holding its regular meeting this weekend in Tampa. Also Friday, it elected new officers for the upcoming year: Dr. Gaston J. Acosta-Rua, a neurosurgeon from Jacksonville, will replace Dr. Georges A. El-Bahri as the board's chairman. Acosta-Rua becomes the first Cuban-American to lead the board in 102 years.

Dr. Zachariah P. Zachariah, a cardiologist from Fort Lauderdale, was named first vice chairman, and Leon, a surgeon in Miami, is the new second vice chairman.